Blog Category Archives: Are you compliant?

• Third Party Record Reviewers: Establishing Better Boundaries through Policies and Procedures

  on May 17th, 2012   by Amy Derlink | No Comments

  Part 5: Reimbursable vs. Non-reimbursable Requests How can an HIM professional know if a request is reimbursable by Third Party Reviewers/Auditors? Several factors determine reimbursement and HIM departments must carefully review the participating provider/ managed care contract for each insurer … Continue reading →

• Third Party Record Reviewers: Establishing Better Boundaries through Policies and Procedures

  on May 10th, 2012   by Amy Derlink | No Comments

  Part 4: ROI and Third Party Record Reviewers Like covered entities, insurers and other external reviewers acting as business associates must have policies and procedures in place to prevent PHI breaches under HIPAA. HIM Departments should always request a copy … Continue reading →

• Third-Party Record Reviewers: Establishing Better Boundaries through Policies and Procedures

  on May 2nd, 2012   by Amy Derlink | No Comments

  Part 3: Onsite and Remote Audits Do not overlook the importance of preparation when creating your policy. Think ahead about assigning a staff member to assist the reviewers and establishing a designated location for record reviews. The location should be … Continue reading →

• Third-Party Record Reviewers: Establishing Better Boundaries through Policies and Procedures

  on April 26th, 2012   by Amy Derlink | No Comments

  Part 2: Establishing a Third Party Audit Policy When establishing your audit policy, keep in mind that only the minimum necessary information should be available to reviewers. The auditing body should provide proof of authenticity, a formal list of requested … Continue reading →

• Third-Party Record Reviewers: Establishing Better Boundaries through Policies and Procedures

  on April 20th, 2012   by Amy Derlink | No Comments

  Part 1: Be proactive in your approach to Third Party Reviewers/Auditors Insurance companies initiate retrospective reviews without disclosing their true intent. They assume compliance by the healthcare provider and are out to seek refunds for services because of “lack of … Continue reading →

• SOC it 2 me!

  on April 13th, 2012   by Amy Derlink | No Comments

  Service Organization Control (SOC) audits help to convey trust and assurance to users of the system that an organization such as IOD has deployed an effective control system to effectively mitigate operational and compliance risks that the system may represent … Continue reading →

• Coming soon: Electronic Signatures for SSA Form

  on April 5th, 2012   by Amy Derlink | No Comments

  Did you know that beginning April 21, 2012, adults filing online for Social Security disability benefits on their own behalf will be able to electronically sign and submit their Authorization to Disclose Information to the Social Security Administration (Form SSA-827)? … Continue reading →

• CMS Increases RAC Medical Record Limit Requests

  on March 22nd, 2012   by Amy Derlink | No Comments

  Are you already overwhelmed by the RACs in your region? Unfortunately, requests for medical records by RAC auditors are on the rise. CMS has increased the annual limit for most providers to 2% of all claims submitted divided by eight.  In … Continue reading →

• MU Stage 2: What’s New?

  on March 8th, 2012   by Amy Derlink | No Comments

  Looking forward toward Meaningful Use Stage 2, here’s a quick snapshot at the more significant MU Stage 2 changes for Eligible Professionals (EP), Eligible Hospitals (EH) and Critical Access Hospitals (CAH). EP: Clinical summaries provided to patients within 24 hours … Continue reading →

• Next steps on the path to Meaningful Use

  on February 6th, 2012   by Amy Derlink | No Comments

  If you’ve established that your ROI vendor is prepared to help you meet Meaningful Use requirements,  you may be wondering: “What next?” The following sequence provides general guidelines for logical subsequent activities. Your ROI vendor should be ready to: Begin tracking … Continue reading →